Kelly Justin Busher, LCSWA, PSS, QP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P018114 Issued in NC

Practice address

127 S Main St Ste H
Mount Holly, NC 28120-1618

Phone

(704) 759-6525

Fax

(704) 601-3470

NPI assigned

Nov 7, 2022

Last updated

Mar 8, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Creative Perspectives PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mount Holly, NC
  • NPI 1215448584
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1699483867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 S CLAY ST",
            "city": "LOWELL",
            "state": "NC",
            "postal_code": "280981811",
            "telephone_number": "704-778-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S MAIN ST STE H",
            "city": "MOUNT HOLLY",
            "state": "NC",
            "postal_code": "281201618",
            "telephone_number": "704-759-6525",
            "fax_number": "704-601-3470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 S Clay St",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "NC",
            "postal_code": "280981811",
            "country_code": "US",
            "telephone_number": "704-778-2201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSHER",
        "first_name": "KELLY",
        "middle_name": "JUSTIN",
        "credential": "LCSWA, PSS, QP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-07",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P018114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doreen Marie Boothroyd, PTA
• John Martin Bradshaw, PA-C
• Joelle Brown Bridges, FNP-C
• Brlvant Behavioral Health Services and Life Coaching, PLLC
• Barbara J Brown, LCSW, RDT
• Nicole M Cady, RD, LDN, CNSC
• Carolina Family Spine Center, PC
• Carolina Speech Academy, PLLC
• Carolinas Physicians Network Inc (The Sanger Clinic)
• Caromont Medical Group Inc (CaroMont Family Medicine)

• Clinical Social Worker in Mount Holly, NC
• Providers in Mount Holly, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.